Objectives

1) Learn the common radiological signs of organ torsion

2) Identify specific signs pertaining to certain organs, for example the ovary

3) Understand the importance of early identification and treatment

4) Highlight the complications of torted viscera including infarction, perforation of hollow viscus and peritonitis

5) Emphasise the pearls and pitfalls in diagnosis

6) Explain management

Background

10% of patients attending the Emergency Department (ED) present with an acute abdomen/abdominal pain as their main symptom. Torsion of abdomino-pelvic viscera is an uncommon cause of pain; however imaging is essential to differentiate from other causes of an acute abdomen. A delay in diagnosis and management can lead to serious complications, increasing the mortality and morbidity of these patients. This poster aims to educate readers on identifying torted abdomino-pelvic viscera on imaging as a cause of an acute abdomen and highlight the potential complications.

Imaging findings OR Procedure findings

TABLE OF CONTENTS/OUTLINE

A) Presenting symptoms

B) Anatomical variant and predisposing factors for organ torsion

C) Pathophysiology

D) Radiological findings with depiction of torsion in different organs including, but not limited to gallbladder, stomach, small bowel, caecum and ovary

E) Discussion of general radiological signs and specific signs pertaining to certain viscera, for example postion of gallbladder in torsion

F) Depiction of complications

G) Pitfalls and Differential diagnosis

H) Management

Conclusion

Torsion of the abdominopelvic viscera is essential to recognise early in order to allow prompt management of the acutely unwell patient.

Objectives

Learning objectives

Identify MRI sequences that can be used for clarifying the T-staging of thoracic Oesophagus cancer

Demonstrate how utilising MRI in oesophageal cancer can help better delineate the tissue planes with adjacent organs and thereby aid in clarifying the T-staging

Highlight specific areas where MRI can problem solve in locally invasive thoracic oesophageal cancer

Background

Background:

The standard tool for assessing the local stage of oesophageal cancer is endoscopic ultrasound (EUS). However, approximately 1 in 20 tumours are impassable by EUS even after endoscopic dilatation. An early study showed MRI to have over 80% accuracy for local staging, and therefore may be comparable to EUS. In this exhibit, we describe a case series where MRI has provided improved clarity in the local T-staging compared to CT in patients where EUS was not possible because of luminal compromise.

Imaging findings OR Procedure findings

Imaging findings:

MRI oesophagus confirming Left atrium involvement

MRI clarifying tumour clearance from the aortic arch and descending thoracic aorta

MRI oesophagus showing tracheal involvement

MRI oesophagus clarifying tumour clearance from the left inferior pulmonary vein

MRI oesophagus showing involvement of pericardium only

These MRI features are demonstrated and compared with the related staging CT images.

Conclusion

Conclusion:

MRI of the oesophagus can provide better clarification of the T-staging of thoracic oesophageal cancer compared to CT and can be an invaluable tool particularly in cases where EUS cannot be performed.